Management of the third stage of labour in women at low risk of postpartum haemorrhage - PubMed (original) (raw)
Clinical Trial
Management of the third stage of labour in women at low risk of postpartum haemorrhage
B Thilaganathan et al. Eur J Obstet Gynecol Reprod Biol. 1993 Jan.
Abstract
Objective: To compare active management with physiological management of the third stage of labour in women at low risk of postpartum haemorrhage.
Design: Randomised allocation of women in labour at low risk of postpartum haemorrhage to either physiological or active management of the third stage.
Setting: Labour ward in a district general hospital.
Patients: 193 Women with spontaneous vaginal delivery at term completed the study. Exclusion criteria were induction or augmentation of labour, antepartum or previous postpartum haemorrhage, premature rupture of membranes, previous caesarean section, raised blood pressure, cervical lacerations and third degree tears.
Interventions: Active management with syntometrine and controlled cord traction; or physiological management, where the cord was not clamped and the placenta was delivered by maternal effort.
Measurements: Blood loss was measured subjectively at delivery and estimated objectively by comparing the haemoglobin in labour with that on the third postpartum day. The duration of the third stage was also measured as was the incidence of retained placenta and blood transfusion.
Results: There was no significant difference in the estimated blood loss or haemoglobin drop between the two groups (P > 0.5). In addition the duration of the third stage was significantly longer in the physiological group (P < 0.001). Out of 90 women having physiological management, 7 received oxytocics for presumed postpartum haemorrhage. Only one case in the active group required further oxytocics and one other case in this group required a manual removal of placenta.
Conclusions: This preliminary study confirms that active management results in a reduction in the length of the third stage of labour. However, it suggests that active management does not reduce blood loss when compared to physiological management in the woman at low risk of postpartum haemorrhage.
Similar articles
- Active versus expectant management for women in the third stage of labour.
Begley CM, Gyte GM, Devane D, McGuire W, Weeks A. Begley CM, et al. Cochrane Database Syst Rev. 2011 Nov 9;(11):CD007412. doi: 10.1002/14651858.CD007412.pub3. Cochrane Database Syst Rev. 2011. PMID: 22071837 Free PMC article. Updated. Review. - The Bristol third stage trial: active versus physiological management of third stage of labour.
Prendiville WJ, Harding JE, Elbourne DR, Stirrat GM. Prendiville WJ, et al. BMJ. 1988 Nov 19;297(6659):1295-300. doi: 10.1136/bmj.297.6659.1295. BMJ. 1988. PMID: 3144366 Free PMC article. Clinical Trial. - Prophylactic oxytocin for the third stage of labour to prevent postpartum haemorrhage.
Westhoff G, Cotter AM, Tolosa JE. Westhoff G, et al. Cochrane Database Syst Rev. 2013 Oct 30;(10):CD001808. doi: 10.1002/14651858.CD001808.pub2. Cochrane Database Syst Rev. 2013. PMID: 24173606 Updated. Review. - Active versus expectant management for women in the third stage of labour.
Begley CM, Gyte GM, Devane D, McGuire W, Weeks A. Begley CM, et al. Cochrane Database Syst Rev. 2015 Mar 2;(3):CD007412. doi: 10.1002/14651858.CD007412.pub4. Cochrane Database Syst Rev. 2015. PMID: 25730178 Updated. Review. - Current strategies for the prevention of postpartum haemorrhage in the third stage of labour.
Chong YS, Su LL, Arulkumaran S. Chong YS, et al. Curr Opin Obstet Gynecol. 2004 Apr;16(2):143-50. doi: 10.1097/00001703-200404000-00008. Curr Opin Obstet Gynecol. 2004. PMID: 15017343 Review.
Cited by
- Active versus expectant management for women in the third stage of labour.
Begley CM, Gyte GM, Devane D, McGuire W, Weeks A. Begley CM, et al. Cochrane Database Syst Rev. 2011 Nov 9;(11):CD007412. doi: 10.1002/14651858.CD007412.pub3. Cochrane Database Syst Rev. 2011. PMID: 22071837 Free PMC article. Updated. Review. - Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes.
McDonald SJ, Middleton P, Dowswell T, Morris PS. McDonald SJ, et al. Cochrane Database Syst Rev. 2013 Jul 11;2013(7):CD004074. doi: 10.1002/14651858.CD004074.pub3. Cochrane Database Syst Rev. 2013. PMID: 23843134 Free PMC article. Review. - Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis.
Gallos ID, Williams HM, Price MJ, Merriel A, Gee H, Lissauer D, Moorthy V, Tobias A, Deeks JJ, Widmer M, Tunçalp Ö, Gülmezoglu AM, Hofmeyr GJ, Coomarasamy A. Gallos ID, et al. Cochrane Database Syst Rev. 2018 Apr 25;4(4):CD011689. doi: 10.1002/14651858.CD011689.pub2. Cochrane Database Syst Rev. 2018. PMID: 29693726 Free PMC article. Updated. Review. - Alternative positions for the baby at birth before clamping the umbilical cord.
Airey RJ, Farrar D, Duley L. Airey RJ, et al. Cochrane Database Syst Rev. 2010 Oct 6;2010(10):CD007555. doi: 10.1002/14651858.CD007555.pub2. Cochrane Database Syst Rev. 2010. PMID: 20927760 Free PMC article. Review. - Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis.
Gallos ID, Papadopoulou A, Man R, Athanasopoulos N, Tobias A, Price MJ, Williams MJ, Diaz V, Pasquale J, Chamillard M, Widmer M, Tunçalp Ö, Hofmeyr GJ, Althabe F, Gülmezoglu AM, Vogel JP, Oladapo OT, Coomarasamy A. Gallos ID, et al. Cochrane Database Syst Rev. 2018 Dec 19;12(12):CD011689. doi: 10.1002/14651858.CD011689.pub3. Cochrane Database Syst Rev. 2018. PMID: 30569545 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical